Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study

Treatment of Two-column Acetabular Fractures by Double Extrapelvic Approach: Three Clinical Cases

Fractures of two columns of the acetabulum according to the Letournel classification are among the most common in frequency, indication and surgical complexity. These are mainly the result of lateral compression mechanisms and are characterized by originating a disconnected acetabulum from the axial skeleton. Its surgical treatment may include: isolated anterior or posterior approach; combined, at the same surgical time or not; or broad approaches. The authors present another surgical option with association of the Kocher-Langenbeck pathway with the iliac crest approach simultaneously and in the same positioning (lateral decubitus) based on the first three clinical cases performed and their clinical and imaging results. In addition to the presentation of the cases, a description of the three characteristic fragments of this type of acetabular fractures, the approach pathway, and the reduction sequence performed are made. From the results obtained and the associated advantages, the authors believe that the addition of the iliac crest approach to the Kocher-Langenbeck pathway may be a very attractive option to consider in the surgical treatment of properly selected fractures of two columns of the acetabula.

Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: an anatomical-morphological study

OBJECTIVE

To digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population.

METHODS

Pelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20 and 60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure.

RESULTS

The combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P < 0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P < 0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P < 0.05). The bending angle (< A) was also significantly smaller in females (P < 0.05).

CONCLUSIONS

The pelvic surface structure is irregular and varies greatly among individuals.Compared to the traditional steel plate, The combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis.

Dislocation Does Not Seem To Be an Absolute Factor Effecting the Short- to Medium-Term Poor Prognosis of Patients with Acetabular Posterior Wall Fracture

Dislocation is a complication of acetabular fractures involving the posterior wall, but whether dislocation is an absolute factor impacting the short- to medium-term prognosis of the hip joint remains controversial. This study aimed to compare the short- to medium-term clinical and radiological results among patients diagnosed with an acetabular fracture involving the posterior wall, with or without dislocation.Seventy-nine patients diagnosed with an acetabular fracture involving the posterior wall were retrospectively divided into posterior dislocation and non-dislocation groups. All fractures were open reduction + internal fixation with a plate screw combination through the single Kocher-Langenbeck approach. The short- to medium-term radiographic outcomes of follow-up were evaluated using the Matta radiologic grading system, while the clinical outcomes were evaluated using the modified Merle d'Aubigné-Postel evaluation system.The mean follow-up duration for all patients was 43.90 (range 24-75) months. Both groups achieved similar short- to medium-term clinical and radiographic results. There seems to be no significant differences between the two groups regarding the short- to medium-term assessment of clinical and radiographic results and the occurrence of postoperative complications (p > 0.05).In patients with acetabular fractures involving the posterior wall, hip dislocation is probably not an absolute determinant of a poor outcome. Even with early reduction, the short- to medium-term prognosis results appear similar to those of patients without dislocation.

Post-traumatic Acetabulum Open Reduction Internal Fixation in a Patient with a BMI of 77: A Case Report

CASE

We present the case of a 25-year-old man with body mass index of 77 who underwent open reduction internal fixation (ORIF) of a displaced fracture dislocation of the acetabulum after a high-speed motor vehicle accident. Remarkably, he achieved full weight-bearing with minimal hip pain and has returned to independent mobility and meaningful work.

CONCLUSION

ORIF of an acetabular fracture in a patient with class III obesity presents many challenges. Positioning, surgical approach, fracture manipulation, and postoperative morbidity and mortality can be managed through interdisciplinary collaboration and preoperative communication.

The value of digital 3D models in evaluating surgical outcomes using the uninjured contralateral acetabulum after acetabular fracture repair

BACKGROUND

Currently, assessment of acetabular fracture reduction is mainly performed by evaluating 2D slices of 3D CT scans. This subjective method can potentially be improved by using 3D models and objective analysis tools. In order to evaluate the potential value of digital 3D reconstructed models in the assessment of acetabular fracture reduction, 3D reconstructions of the fractured acetabulum were compared to the mirrored healthy contralateral side for both the pre-, and post-surgical setting.

METHODS

Thirteen patients with one-sided acetabular fractures were included in the study. All patients received a pre-, and postoperative CT scan. The similarity between the healthy acetabulum and the contralateral fractured acetabulum was determined by two observers for both the pre-, and postoperative setting by completing the following four steps; (1) mirroring of the fractured acetabulum, (2) initial manual alignment of this mirrored 3D model to the contralateral version, (3) surface-based matching (iterative closest point registration) using the acetabular cartilage surface, and (4) calculating the surface distances between affected and healthy acetabular 3D models. Descriptive statistics showed the surface distance between pre-, and post-surgical reduction, as well as the interobserver variability.

RESULTS

A total of 13 patients with an acetabular fracture were included; 11 males and 2 females with a mean ± SD age of 55.6 ± 14.7 years. Digital mirroring of the fractured acetabula to the healthy acetabula was successful for both preoperative and postoperative situations in all patients. The median distance between both fractured and mirrored healthy contralateral acetabula was significantly larger (p<0.01) for the preoperative group (2.21 mm (interquartile range (IQR): 1.30 mm)) compared to the postoperative group (0.93 mm (IQR: 0.59 mm)). The median distance deviation was not significantly different (p = 0.96) between observers.

CONCLUSIONS

The results of comparing 3D model of fractured acetabula with the contra-lateral healthy acetabula before, and after surgical repair indicate that this method can be a suitable tool to objectively assess acetabular fracture reduction. Further research is needed to confirm the usefulness to predict future arthrosis after surgical repair.

Intra-articular fragment mapping in associated both-column acetabular fractures

INTRODUCTION

Associated both-column acetabular fractures (ABC-AF) are complex. A detailed description of the morphology of the articular surface of the acetabulum is not reported. This study was designed to describe the morphology of the intra-articular fragments using a fracture mapping technique to provide reference in more appropriate approach selection in surgical treatment of the fractures.

MATERIALS AND METHODS

Three-dimensional reconstruction CT images from 100 cases of ABC-AFs were retrospectively analyzed using Mimics and 3-matic software. The fractured as well as the reduced three-dimensional models were investigated, and the intra-articular fragments were identified. The distribution of the fracture lines of each main fragment and the overlapping lines of all the fragments were verified on the images.

RESULTS

The articular surface of ABC-AFS consist of three types of fragments: column fragment (CF), wall fragment (WF) and isolated fragment (IF), with the total number varying from 2 to 6. CF characterized by long fracture lines exited to periphery of innominate bone while the lines of WF were confined to the walls. IF was a free fragment found in the dome and in the quadrilateral plate. The surface was composed only by CFs in 17 cases (17%), by CFs and WFs in 59 cases (59%) and by all fragments in 24 cases (24%). The distribution of the overall fracture lines was a "dumbbell shaped" pattern, starting from the infero-anterior aspect, passing through the junction of the fossa to the anterior lunate surface and extending into the posterior region of the acetabulum.

CONCLUSIONS

The articular fragments of ABC-AFs were composed of CFs, WFs and IFs. The junction of the fossa to the anterior lunate surface and the posterior region of the rim were mostly involved. The location of the articular fragments and their connections to the periphery of the innominate may be considered in selection of approaches.

A review of Risk Factors for Post-traumatic hip and knee osteoarthritis following musculoskeletal injuries other than anterior cruciate ligament rupture

Post-traumatic osteoarthritis (PTOA) is a common form of osteoarthritis that might occur after any joint trauma. Most PTOA publications mainly focus on anterior cruciate ligament (ACL) injuries. However, many other traumatic injuries are associated with PTOA, not only for the knee but also for the hip joint. We aim to identify and summarize the existing literature on the musculoskeletal injuries associated with knee and hip PTOA and their risk factors in determining those with a worse prognosis, excluding ACL injuries. Despite the narrative nature of this review, a systematic search for published studies in the last twenty years regarding the most relevant injuries associated with a higher risk of PTOA and associated risk factors for OA was conducted. This review identified the six more relevant injuries associated with knee or hip PTOA. We describe the incidence, risk factors for the injury and risk factors for PTOA of each. Meniscal injury, proximal tibial fracture, patellar dislocation, acetabular, femoral fractures and hip dislocations are all discussed in this review.

A novel anatomical self-locking plate fixation for both-column acetabular fractures

PURPOSE

To compare the stability of the posterior anatomic self-locking plate (PASP) with two types of popular reconstruction plate fixation, i.e. double reconstruction plate (DRP) and cross reconstruction plate (CRP), and to explore the influence of sitting and turning right/left on implants.

METHODS

PASP, DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum. A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left.

RESULTS

The peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP > DRP > PASP. The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right; and the minimal was 234.0 Mpa and 0.619 mm when turning left.

CONCLUSION

PASP can provide higher stability than DRP and CRP for both-column acetabular fractures. The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side, which can avoid implant failure.

Fixation of bilateral acetabular fractures using the modified Stoppa approach: Two-year clinical outcomes

OBJECTIVES

This study aims to evaluate the two-year clinical results of bilateral acetabular fractures operated via a single incision with the modified Stoppa approach.

PATIENTS AND METHODS

Between January 2013 and January 2020, a total of 22 acetabular fractures of 11 patients (7 males, 4 females; mean age: was 42.9±13.7 years; range, 19 to 62 years) who were operated via the modified Stoppa approach were retrospectively analyzed. The medical records were analyzed in terms of time to surgery, fracture patterns, Injury Severity Score (ISS), operation duration, blood loss, reduction quality, perioperative complications and concomitant injuries. Reduction quality was assessed according to Matta's criteria. The Harris Hip Score (HHS) and modified Merle d'Aubigne score (MDS) were utilized for functional assessment.

RESULTS

The mean follow-up was 49±15 (range, 30 to 79) months. The mean ISS was 28.2±7.2. The mean modified MDS was 15.90±1.57. The mean HHS was 84.27±8.85. For both sides, reduction was anatomical-anatomical (63.6%) in seven patients, anatomical-imperfect in three (27.3%) patients, and imperfectpoor in one (9.1%) patient. According to the Kellgren-Lawrence radiological evaluation at 24 months of follow-up bilaterally, Grade 0-1 osteoarthritis was observed in six (54.5%) patients, Grade 1-1 in four (36.4%) patients, and Grade 1-2 osteoarthritis in one (9.1%) patient.

CONCLUSION

The modified Stoppa approach in bilateral acetabular fractures seems to be more preferable than other approaches, as it can be performed with a single incision and provides less bleeding, shorter operation duration, and satisfactory results.

Both-Column Acetabular Fractures: Should Pelvic Ring Reduction or Acetabulum be Performed First?

OBJECTIVE

Both-column acetabular fracture is a type that accumulates both the pelvis and acetabulum with complex fracture line alignment and has variant fracture fragments. The selection of different reduction landmarks and sequences produces different qualities of reduction. This study aims to compare the operation-related items, quality of reduction, and hip functional outcome by using different reduction landmarks and sequences for management of both-column acetabular fractures (BCAF).

METHODS

A consecutive cohort of 42 patients from January 2013 to January 2019 with BCAF were treated operatively with different reduction landmarks and sequences: pelvic ring fractures reduction first (PRFRF group) and acetabular fractures reduction first (AFRF group). Preoperative computer visual surgical procedures were applied. There were 22 patients in PRFRF group and 20 patients in AFRF group. The surgical details, complications, radiographic and clinical results were recorded. The quality of reduction was assessed by the Matta scoring system. The functional outcome was evaluated by the modified Merle d'Aubigné and Postel scoring system. The measurement data were analyzed using the t-test of independent samples and rank-sum test of ranked data.

RESULTS

The real reduction sequence in both groups was almost identical to the preoperative surgical procedures. The excellent/good quality of reduction in PRFRF group (21/22) was better than AFRF group (17/20). Operative time (152.3 ± 16.3 mins) and intra-operative blood loss (639.5 ± 109.9ml) were significantly reduced in PRFRF group (p < 0.05). The incidence of deep vein thrombosis in PRFRF group (2/22) was less than AFRF group (4/20), but without statistical signification.

CONCLUSION

Selection of an appropriate reduction landmark and sequence could result in better quality of reduction, operative time, and decreased blood loss during treatment of BCAF.

Associated both-column acetabular fracture: An overview of operative steps and surgical technique

The management of both-column fractures of the acetabulum is challenging for the orthopaedic surgeon. Operative treatment is usually recommended in this particular fracture pattern, as residual joint surface displacement has been shown to increase local contact stress, drastically leading to rapid cartilage destruction. In this review, we present an overview of operative steps and surgical technique for both-column acetabular fracture reconstruction. Therefore, we demonstrate how correct understanding of fracture morphology and displacement, preoperative preparation, including choice of approach and patient positioning, reduction strategies, and programmed sequential fixation, starting from superior fracture lines on the anterior acetabular column and ending on the posterior components of this fracture type, may provide satisfactory outcomes in this difficult acetabular fracture pattern.

Treatment of Incarcerated Impaction of Acetabular Fractures With Concomitant Osteochondral Femoral Head Fractures by the Use of a Posterior Wall Osteotomy and Surgical Hip Dislocation: A Novel Technique

Acetabular articular impaction may well accompany acetabular fractures. Anatomic restoration of acetabular congruence is imperative to achieve longevity of the hip joint. Combination of incarcerated acetabular impaction with osteochondral femoral fracture is a true challenge for the pelvic surgeon to address. We describe a technique to treat a posterior column acetabular fracture in association with incarcerated articular impaction and concomitant osteochondral femoral fracture. Posterior wall osteotomy combined with surgical hip dislocation facilitates the restoration of femoral head anatomy and acetabular surface integrity. This technique should be considered when dealing with this difficult scenario.

The value of 3D reconstructions in determining post-operative reduction in acetabular fractures: a pilot study

Background

In patients with acetabular fractures, the reconstructed three-dimensional (3D) model of the contralateral acetabulum could be used as a mirrored template for the anatomical configuration of the affected joint. This has not been validated.

Objective

To investigate whether the right and left acetabula, as reconstructed 3D models, are valid mirrored duplicates that can be used as a reference model for the contralateral side.

Methods

CT scans of twenty patients with unaffected acetabula were used. The symmetry of the generated 3D models was evaluated through: (1) mirroring of the acetabulum; (2) initial rough matching; (3) automatic optimisation of the matching via surface-based matching; (4) calculation of distances between surfaces by evaluating the Euclidean (straight-line) error distance between the closest points between left and right. The percentages of surface points of the left and right acetabulum with a distance smaller than 0.5, 1.0, 1.5 and 2.0 mm were calculated and evaluated, in relation to Matta’s criteria, for acetabular fracture reductions.

Results

The mean distance deviation was less than 0.75 mm in all 40 comparisons. The calculated distances in 90.7% of the surface points of the left and right acetabulum were below the tolerance threshold of 1.0 mm, based on Matta’s anatomical reduction criteria, and 98.7% of the surface points scored below Matta’s imperfect tolerance threshold of 2.0 mm.

Conclusion

This study demonstrates 3D reconstructed models of healthy left and right acetabula are highly similar and could potentially be used as mirrored duplicates. The next step will be to investigate these results in patients with reduced acetabular fractures.

Outcomes after surgical treatment of acetabular fractures: a review

Acetabular fractures are fractures that extend into the hip joint and pose a challenge for orthopaedic trauma surgeons. The first known descriptions of surgical fixation of acetabular fractures were case reports in 1943. In 1964, Robert Judet, Jean Judet, and Émile Letournel published a landmark article describing a classification system and surgical approaches to treat acetabular fractures. These teachings had a significant effect on clinical outcomes after surgical fixation of acetabular fractures. In 1980, Letournel demonstrated 80% good-to-excellent results in 492 hips, and in 2012, Joel Matta demonstrated 79% survivorship in 816 patients follow surgical acetabular fixation. Both Letournel and Matta have definitively shown that anatomic reduction of the fracture is the most influential factor predictive of clinical outcome. The intent of this review is to summarize the salient factors affecting clinical outcomes after surgical treatment of acetabular fractures.

Long-Term Patient-Reported Functional Outcome of Polytraumatized Patients With Operatively Treated Pelvic Fractures

OBJECTIVES

To report the long-term functional outcome of a cohort of patients with operatively treated unstable pelvic fractures using validated patient-reported outcome measures.

DESIGN

Long-term observational study using prospective and retrospective data.

SETTING

Tertiary referral pelvic trauma center, Bristol, United Kingdom.

PATIENTS

Seventy-four polytraumatized patients with operatively treated unstable pelvic ring injuries (50 OTA/AO type B and 24 OTA/AO type C, mean Injury Severity Score 17) treated between 1994 and 2005.

INTERVENTION

Sixty-four (86%) patients were treated with internal fixation. The remaining 10 patients (14%) were treated with either combined percutaneous posterior fixation and anterior external fixation or external fixation in isolation.

MAIN OUTCOME

Patient-reported functional outcome.

MEASUREMENTS

Short Form-36, with UK norm-based comparator scores and EQ-5D-3L.

RESULTS

Patients were between 11 and 22 years after injury (mean 15 years). We found no significant association between fracture classification and outcome score, but compared with age- and sex-matched scores for a UK population, differences were statistically significant in 3 of the 8 domains of health: physical function (P = 0.04), bodily pain (P = 0.001), and vitality (P = 0.001). The level of disability remained constant for these patients compared with their patient-reported outcome measure scores reported 8 years previously.

CONCLUSION

Patients who sustain an unstable pelvic fracture continue to have significant functional limitations compared with an uninjured population. These changes were not found to be related to age, injury pattern, genitourinary injury, or neurological injury. Functional outcome scores did not change over the 2 long-term time points.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Minimally invasive treatment of both-column acetabular fractures through the Stoppa combined with iliac fossa approach

Both-column fractures are the most complicated group of acetabular fractures. Although great progress of surgical technique has been made, the choice of approach is controversial. All the fragments could be exposed and managed through combined ilioinguinal and Kocher-Langenbeck (IL+KL) approaches, which has been widely used to conduct the both-column fractures. However, the clinical popularization may be restricted for high rate of complication. Most internal area of the hemipelvis could be exposed through Stoppa combined with iliac fossa (S+IF) approach. The majority of both-column fractures were managed through IL+KL approaches or S+IF approach in our institution. The comparison of the two surgical methods was done in this study. The purpose is to examine whether S+IF approach could achieve the satisfactory reduction and fixation for both-column fractures.

Posterior Wall Osteotomy of the Acetabulum to Access Incarcerated Marginal Impaction

Marginal impaction of the acetabulum is typically accessible through fracture planes specific to the nature of the injury. Infrequently, however, incarcerated marginal impaction or free osteochondral fragments are not accessible through these existing fracture planes. As such, alternative methods to access these articular pieces must be considered to ensure adequate reduction. We describe an osteotomy of the posterior wall to access incarcerated fragments and marginal impaction of the acetabulum, enabling concentric articular reduction.

Patients undergoing surgical hip dislocation for the treatment of acetabular fractures show favourable long-term outcome

Aims

The aims of this study were to determine the cumulative ten-year survivorship of hips treated for acetabular fractures using surgical hip dislocation and to identify factors predictive of an unfavourable outcome.

Patients and Methods

We followed up 60 consecutive patients (61 hips; mean age 36.3 years, standard deviation (sd) 15) who underwent open reduction and internal fixation for a displaced fracture of the acetabulum (24 posterior wall, 18 transverse and posterior wall, ten transverse, and nine others) with a mean follow-up of 12.4 years (sd 3).

Results

Clinical grading was assessed using the modified Merle d’Aubigné score. Radiographic osteoarthritis was graded according to Matta. Kaplan-Meier survivorship and a univariate Cox-regression analysis were carried out using the following endpoints: total hip arthroplasty, a Merle d’Aubigné score of < 15 and/or progression of osteoarthritis.

Conclusion

The ten-year cumulative survivorship was 82% (95% confidence interval 71 to 92). Predictors for the defined endpoints were femoral chondral lesions, marginal impaction, duration of surgery, and age of patient. Cite this article: Bone Joint J 2017;99-B:508–15.

Predictive value of clinical scoring and simplified gait analysis for acetabulum fractures

BACKGROUND

Fractures of the acetabulum show a high, long-term complication rate. The aim of the present study was to determine the predictive value of clinical scoring and standardized, simplified gait analysis on the outcome after these fractures.

METHODS

Forty-one patients with acetabular fractures treated between 2008 and 2013 and available, standardized video recorded aftercare were identified from a prospective database. A visual gait score was used to determine the patients walking abilities 6-m postoperatively. Clinical (Merle d'Aubigne and Postel score, visual analogue scale pain, EQ5d) and radiological scoring (Kellgren-Lawrence score, postoperative computed tomography, and Matta classification) were used to perform correlation and multivariate regression analysis.

RESULTS

The average patient age was 48 y (range, 15-82 y), six female patients were included in the study. Mean follow-up was 1.6 y (range, 1-2 y). Moderate correlation between the gait score and outcome (versus EQ5d: r_s = 0.477; versus Merle d'Aubigne: r_s = 0.444; versus Kellgren-Lawrence: r_s = -0.533), as well as high correlation between the Merle d'Aubigne score and outcome were seen (versus EQ5d: r_s = 0.575; versus Merle d'Aubigne: r_s = 0.776; versus Kellgren-Lawrence: r_s = -0.419). Using a multivariate regression model, the 6 m gait score (B = -0.299; P < 0.05) and early osteoarthritis development (B = 1.026; P < 0.05) were determined as predictors of final osteoarthritis. A good fit of the regression model was seen (R² = 904).

CONCLUSIONS

Easy and available clinical scoring (gait score/Merle d'Aubigne) can predict short-term radiological and functional outcome after acetabular fractures with sufficient accuracy. Decisions on further treatment and interventions could be based on simplified gait analysis.

Surgical hip dislocation is a reliable approach for treatment of femoral head fractures

BACKGROUND

Femoral head fractures are rare injuries; incongruency and instability are indications for surgical intervention. Anterior, posterior, and transtrochanteric surgical approaches have been proposed, but the exposure is limited with classical approaches. Surgical hip dislocation allows for a 360° view of the head and may facilitate a reduction in selected head fractures, but to our knowledge, few studies have reported on the results with this technique. We therefore report on the (1) quality of fracture reduction; (2) modified Harris hip score at a minimum of 2 years (mean, 6 years, range, 26-122 months); and (3) frequency of complications, including avascular necrosis (AVN), arthritis development, and heterotopic ossification, in a case series of patients with femoral head fractures treated with this approach.

DESCRIPTION OF TECHNIQUE

The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. Using this technique we are able to reduce all displaced femoral head fractures under direct view. Definitive fixation is performed through this approach with 2.7-mm nonabsorbable screws. The same technique may be used also for Pipkin IV fractures to fix transverse, T-type, posterior wall, or posterior column acetabular fracture.

METHODS

Between 2004 and 2011, we used this approach to manage all displaced femoral head fractures in patients younger than 55 years old. A total of 17 patients were thus treated; of those three were lost to followup before 2 years, and one was excluded from study because of severe preoperative neurological impairment, leaving 13 for analysis here. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs. Outcomes were evaluated with the modified Harris hip score. Minimum followup was 24 months (mean, 77 months; SD, 32.8 months).

RESULTS

Fracture reduction was anatomic in eight hips and imperfect in five. Mean clinical score was 82 points (SD, 7.7). One patient developed symptomatic femoral head AVN and underwent total hip arthroplasty 4 years after the index procedure; no other patient underwent arthroplasty. Besides this patient, signs of arthritis (Grade I according to Tönnis classification) were found in one patient and heterotopic ossification was recorded in two patients, but neither was symptomatic.

CONCLUSIONS

Our experience with surgical dislocation shows clinical results comparable to previously reported outcomes in femoral head fractures treated with common approaches; we also present a similar rate of AVN and a lower rate of posttraumatic arthritis, but a higher risk of heterotopic ossification. Further case-control studies are necessary to confirm these statements.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Late surgery for acetabular fractures in a Chinese level I trauma centre: surgical experience and outcomes

PURPOSE

Delayed surgical management of acetabular fractures, often necessary due to life-threatening concomitant injuries, is a great challenge because delays may potentially increase complications and decrease outcomes. We report clinical outcomes of 61 acetabular fractures treated by delayed open reduction and internal fixation (ORIF) with an injury-to-surgery interval (ISI) of 22-399 days.

METHODS

Operations were performed between April 2001 and December 2008. There were 61 cases (42 men 19 women), with an average age of 38 years. All patients were followed for an average of 82 months. Demographic data, fracture pattern, ISI, concomitant injuries, surgical approach, complications and clinical outcomes were recorded and analysed. There were 16 simple fractures (26.2%) and 45 associated fractures (73.8%). Matta criteria were used to evaluate reduction quality. The Merle d'Aubigné and Postel scoring system was employed to assess post-operative functionality.

RESULTS

Anatomical reduction was achieved in 45 cases (73.8%). The clinical result was excellent in 38 cases, good in 13, fair in six and poor in four. Osteonecrosis of the femoral head was observed in three cases, and heterotopic ossification was found in 28 cases. Four patients had transient palsy of the sciatic nerve.

CONCLUSIONS

ORIF for fresh acetabular fractures might yield a better prognosis; however, for delayed acetabular fractures, clinical outcomes are also predictable when sophisticated surgical techniques are employed. Our results indicate that delayed ORIF could yield satisfactory clinical outcomes in the majority of patients with acetabular fractures.

A reduction clamp for an aiming component in associated acetabular fractures

BACKGROUND

The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed.

MATERIALS AND METHODS

In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures.

RESULTS

This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp's aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use.

CONCLUSION

This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.